Carotid endarterectomy with primary closure does not adversely affect the rate of recurrent stenosis.

Objectives: To review our results with carotid endarterectomy using primary closure and to study the incidence of true recurrence in this group of patients. A secondary objective was to review the effect of risk factors on recurrence of stenosis following carotid endarterectomy.

Design: Cohort study.

Setting: University hospital.

Patients: Over 3 years, 232 patients underwent 268 endarterectomies.

Indications: Transient ischemic attacks developed in 119 patients, asymptomatic stenosis in 108 patients, and stroke in 41 patients. One hundred fifty-seven patients (184 operations) qualified for late analysis by completing all aspects of follow-up.

Outcome Measures: Serial duplex scans recorded stenosis (> 50% diameter reduction). Clinical evaluation identified transient ischemic attacks and stroke.

Results: Overall, 12 recurrent stenoses developed in the 184 patients available for study during a follow-up of 24 months (6.5% incidence of late stenosis). Of these 12 patients, only eight had either a normal completion angiogram or a normal carotid duplex scan within 3 months of surgery, thus qualifying for analysis as having developed true recurrent stenosis. True recurrent stenosis occurred in eight (4.3%) of 184 patients. Risk factor analysis did not reveal a statistically significant impact on recurrent stenosis, but several trends were identified. Gender and consumption of tobacco may predispose toward the development of recurrent stenosis.

Conclusion: Recurrent stenosis is sufficiently uncommon following primary closure to justify continued use of this technique. Patch angioplasty may be considered in women and smokers.